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目的探讨在肺表面活性物质治疗新生儿呼吸窘迫综合征(RDS)后,预防性应用布洛芬减少动脉导管未闭(PDA)等合并症的疗效及安全性。方法选择2011年1月至2013年2月本院新生儿重症监护室收治的RDS早产儿,应用肺表面活性物质治疗后随机分为预防性使用布洛芬组(预防组)和不预防性使用布洛芬组(对照组)。比较两组患儿发生PDA比例、辅助通气时间以及肺出血、死亡情况;观察预防性使用布洛芬的不良反应,并进行统计学分析。结果预防组(23例)和对照组(28例)患儿生后7～10天内超声心动图检测出PDA的例数分别为1例(4.3%)和14例(50%),差异有统计学意义(P<0.01);辅助通气时间分别为(116.0±44.5)h和(114.3±57.7)h,差异无统计学意义(P>0.05);两组均未出现肺出血和死亡患儿,未出现出血倾向、坏死性小肠结肠炎、胃肠道穿孔破裂等情况。两组少尿、血肌酐>140μmol/L、上消化道出血或出血加重、喂养不耐受发生率差异均无统计学意义(P>0.05)。结论在应用肺表面活性物质治疗新生儿RDS后,预防性应用布洛芬可以显著减少PDA发生,安全有效。
Objective To investigate the efficacy and safety of prophylactic ibuprofen in reducing complications such as patent ductus arteriosus (PDA) after pulmonary surfactant treatment of neonatal respiratory distress syndrome (RDS). Methods Preterm infants with RDS admitted to our Neonatal Intensive Care Unit from January 2011 to February 2013 were randomly divided into prophylactic use of ibuprofen (prophylaxis group) and non-prophylactic use of pulmonary surfactant after treatment Ibuprofen group (control group). The proportion of PDA, the duration of assisted ventilation, and pulmonary hemorrhage and death were compared between the two groups. Adverse reactions of ibuprofen were observed and statistically analyzed. Results The number of PDA detected by echocardiography in 7 (superscript th) and 10 (superscript th) days after birth in prevention group (23 cases) and control group (28 cases) were 1 case (4.3%) and 14 cases (50%), respectively (P <0.01). The time of assisted ventilation was (116.0 ± 44.5) h and (114.3 ± 57.7) h, respectively, with no significant difference (P> 0.05). There was no pulmonary hemorrhage or death in both groups, No bleeding tendency, necrotizing enterocolitis, gastrointestinal perforation rupture and so on. Two groups of oliguria, serum creatinine> 140μmol / L, upper gastrointestinal bleeding or bleeding aggravated, the incidence of feeding intolerance differences were not statistically significant (P> 0.05). CONCLUSIONS: Prophylactic ibuprofen can reduce the incidence of PDA safely and effectively after the application of pulmonary surfactant to treat neonatal RDS.